Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Universal health coverage could save $1T and 114k lives a year: study

ysph.yale.edu

Post reply on HN
Print view View original

551–560 of 1001 posts

Re: Universal health coverage could save $1T and 114k lives a year: study

#551

Post by jjav »

HEmanZ wrote: post #406
nullocator wrote: post #345

Earlier quoted context omitted.

> Hospitals have an operating margin of 2-5% Very curious where this comes from and how accurate it is. For example the $37 a provider charges for an Aspirin seems like more than 2-5% margin.

You can search for more reports, because they do vary based on methodology. But the median hospital in the US makes between -1% (yes, negative, they lose money, because a huge percentage are non profits) and 4% depending on the source. When the hospital charges you $37 for an aspirin, that singular pill might have a crazy profit margin in isolation. But your entire treatment could very well be losing the hospital mon…

It is a system where all prices and costs are so far detached from reality for multiple reasons, that looking at any current profit margins is not going to be very realistic either.

Really need to step back and start from first principles.

When I go to urgent care I get 15 minutes with a doctor who on average makes about $300K and maybe another 15 minutes with a nurse assistant who might be making $100K (or less). So that is less than $50 in doctor+nurse salary. Of course there are then all the overhead of rent, utilities, etc, etc but those are not so different from any other business in the same strip mall. So let's say total cost for my visit is maybe $100. But I'm charged $500-$600 for the visit. Someone is pocketing a lot of money and it is not the doctor nor the nurse.

We could do the same exercise for surgery, the costs for surgeons and anestethicians is much higher, but you'll be hard pressed to find any realistic scenario where the cost of a two hour surgery is more than $100K.

Re: Universal health coverage could save $1T and 114k lives a year: study

#552

Post by atmavatar »

jaredklewis wrote: post #470
atmavatar wrote: post #452

Earlier quoted context omitted.

> Hospitals have an operating margin of 2-5% I'm curious where you got this figure, because it doesn't track with my own experience. I used to work for a place that worked closely with hospital clients (and prospective clients) to resolve billing issues with a particular EMR system, and we regularly discovered that a given hospital was losing hundreds of thousands to millions of dollars weekly due to missing charges.…

Not the parent, but here's one source: https://www.vizient.com/insights/reports/national-hospital-f... There are many others as well. FWIW, your experience doesn't seem contradictory to the operating margin claims. Your experience seems to be that hospitals are run very inefficiently, implying that if they were run efficiently that their operating margins would be much higher than 2-5%. That may be the case, but that…

To be fair, my experience has been exclusively with hospitals running a specific EMR with a relatively new-ish (at the time) and difficult to configure billing system. Still, we were expecting to see shortfalls nearly an order of magnitude smaller than what we found.

That the hospitals didn't seem to notice the problem, and upon being told of it, often pushed back against moving to fix the problem, is what gave the impression that they must be running on much larger margins than advertised.

Re: Universal health coverage could save $1T and 114k lives a year: study

#553

Post by loeg »

93po wrote: post #548
joquarky wrote: post #543

Earlier quoted context omitted.

Not buying any of this when the world is now full of dark patterns¹ and the ultimate result is that people in charge keep getting richer, faster. ¹ https://en.wikipedia.org/wiki/Hollywood_accounting

This is immediately what came to mind to me. You can be extremely profitable but paying out tens of billions in dividends, or a million other things.

Dividends aren't a Loss.

Re: Universal health coverage could save $1T and 114k lives a year: study

#554

Post by loeg »

ThrowawayTestr wrote: post #514
brandonb wrote: post #113

I'd like to believe this, but the study makes a bunch of really hasty assumptions. The authors derive the $1T number from $1.3T in total cost savings and $304B in incremental spend (incremental spend is due to insuring more people). The $1.3T in cost savings come from five big buckets: lower pharmaceutical prices, Medicare-level payments to providers, reduced administrative overhead, less fraudulent billing, and fewe…

Why is the United States the only country on Earth where free healthcare doesn't work?

The US' healthcare model is not unique, and almost no countries have zero-cost-to-consumer healthcare systems (and none of them are free -- they're just paid by taxpayers instead of consumers). "Free" healthcare is the exception rather than some kind of international norm you incorrectly make it out to be.

The first step to reforming US healthcare is actually understanding it, and understanding some international designs. Lying about it doesn't help.

Re: Universal health coverage could save $1T and 114k lives a year: study

#555

Post by loeg »

ryaniscool wrote: post #383
tptacek wrote: post #309

Earlier quoted context omitted.

The US has top-tier cancer survival-after-diagnosis outcomes. We spend too much to get there, and other countries in our cohort would "argue" that we get those numbers in part by diagnosing earlier and that our outcomes are broadly similar, but if you're going into these debates with "the US private health care system causes cancer deaths", that's a pretty rebuttable argument.

This is a cherry picked statistic. We still have lower life expectancy, high infant mortality rates, and one of the highest rate of preventable and treatable deaths among developed countries

Our life expectancy and infant mortality rates are downstream of driving a lot of miles and unhealthy behaviors (mostly diet and exercise) of American mothers (i.e., obesity). Those are things it would be good to improve, but it isn't the fault of the ER or L&D departments or their billing models that people get in car accidents or mothers are obese.

Re: Universal health coverage could save $1T and 114k lives a year: study

#556

Post by loeg »

tptacek wrote: post #288
satnhak wrote: post #272

Come to a country with universal healthcare (England) and realise that if you work then you're paying 5x the market price for the worst healthcare imaginable. MRI scan - we don't know, one month wait, maybe two. Operation - are you going to die tomorrow with out it? No, ok then that could be years. You need to pay rock bottom wages to doctors to make it work, so guess what all the good doctors leave for private healt…

One of my favorite health care facts: there are more MRI machines in the state of Massachusetts than there are in the entire country of Canada.

I think this one might not be true anymore. Canada has 432 machines as of ~2023 (340 in 2015) and MA is on the order of ~300 (can't find exact figures). It's still a lot lower per capita (10.8 per million vs 42 per million).

Re: Universal health coverage could save $1T and 114k lives a year: study

#557

Post by no-name-here »

maxlybbert wrote: post #292
no-name-here wrote: post #166

Earlier quoted context omitted.

> It only works if providers don't have better options than medicare reimbursement rates. 1. A number of other developed countries have UHC while also allowing a private system as well - what is unique about the US that other countries' existing approach couldn't work here? 2. Less importantly, in this world where everyone has medicare, but a smaller fraction have private coverage, your argument is that the existing…

> 1. A number of other developed countries have UHC while also allowing a private system as well - what is unique about the US that other countries' existing approach couldn't work here? Mainly, expectations. I understand that UHC in European countries doesn’t cover all the things Americans assume it does. Japan apparently keeps costs down by not using cutting-edge drugs. That’s not going to happen in the US. The US…

The US is dead last in terms of health outcomes among every developed country (despite spending far more), but you believe expectations will cause every other developed country's system to fail here? I guess your argument is that the propaganda machine pushing the idea that America's healthcare is not the worst in terms of outcomes (while also being about the most expensive), would prevent Americans from accepting no longer having the worst results and the highest costs?

> Many providers don’t accept Medicare. Very few providers accept Medicaid.

1. About the same percent accept Medicare as private insurance (85-90%, while ~70% accept Medicaid - is that "very few"?).

2. "Medicare for all" is one of the primary proposals being discussed.

3. Previous smaller expansions of government healthcare resulted in expanded provider capacity to handle them, not less, but your argument is that we'd see the opposite results from further expansion?

4. And in this new world where everyone had Medicare or similar, your argument is that providers would choose to ignore most patients, where they don't under the existing system where government-sponsored healthcare makes up a significantly smaller portion of the customer base?

5. And your argument is that if the government finds that healthcare providers contract to the point that outcomes remain the worst among every developed country, as they are today, that the government would be unwilling to make any changes (such as reimbursement rates) to address this?

Re: Universal health coverage could save $1T and 114k lives a year: study

#558

Post by loeg »

DrScientist wrote: post #230

As I understand it - ~30% of US federal spending is on health care. In the UK it's about 20%. Yet apparently the UK is mostly nationalised under the NHS, while in the US there is huge additional spending on private insurance. Can somebody from the US explain to me how that's the case and why American's still put up with it?

US federal budget is 23% of GDP, while UK is 44% of GDP. You can't compare fractions of the fractions directly. (Total spend is something like 11% vs 18% GDP.)

Re: Universal health coverage could save $1T and 114k lives a year: study

#559

Post by tptacek »

loeg wrote: post #556
tptacek wrote: post #288

Earlier quoted context omitted.

One of my favorite health care facts: there are more MRI machines in the state of Massachusetts than there are in the entire country of Canada.

I think this one might not be true anymore. Canada has 432 machines as of ~2023 (340 in 2015) and MA is on the order of ~300 (can't find exact figures). It's still a lot lower per capita (10.8 per million vs 42 per million).

So the new comparison is Canada and Illinois. I can remember that! :)

(Thanks for catching this! I had no idea.)

This is super weird, isn't it? Some of it is obviously overprescription on the US side, but also: Canada could just get more machines.

Re: Universal health coverage could save $1T and 114k lives a year: study

#560

Post by shibapuppie »

jjav wrote: post #551
HEmanZ wrote: post #406

Earlier quoted context omitted.

You can search for more reports, because they do vary based on methodology. But the median hospital in the US makes between -1% (yes, negative, they lose money, because a huge percentage are non profits) and 4% depending on the source. When the hospital charges you $37 for an aspirin, that singular pill might have a crazy profit margin in isolation. But your entire treatment could very well be losing the hospital mon…

It is a system where all prices and costs are so far detached from reality for multiple reasons, that looking at any current profit margins is not going to be very realistic either. Really need to step back and start from first principles. When I go to urgent care I get 15 minutes with a doctor who on average makes about $300K and maybe another 15 minutes with a nurse assistant who might be making $100K (or less). So…

How much does insurance, legal representation, a department to argue with insurers, etc cost the hospital?
Post reply on HN